Abstract
Background: Pradhan Mantri Jan Arogya Yojana (PMJAY) is the world’s largest publicly funded health insurance scheme with over 500 million beneficiaries. It was formulated to provide financial risk protection against health expenditures among the socio‑economically bottom 40% of the Indian population.
Objective: To understand equity in surgical care provision under PMJAY by examining patterns across five dimensions: health sector, gender, age, surgical specialty, and geographical distribution.
Methodology: We reviewed multiple policy briefs and working papers by the National Health Authority.
Results: For both supply and utilization sides, PMJAY is predominantly about surgical care services. About 65% of procedures listed in the scheme cover surgeries and ~82% empaneled hospitals provide surgical care. Regardless of the health sector, over two‑thirds of claims by volume and value were raised for surgical patients. However, key differences and disparities exist in utilization across dimensions. Men have 23.6% greater surgical claims than women beneficiaries, after excluding obstetric and gynecological surgeries. Regional disparities exist with states like Bihar, Madhya Pradesh, and Uttar Pradesh having lower service utilization compared with Gujarat and Kerala. Only 7% of hospitals in “Aspirational Districts” offer specialized surgeries such as cardiothoracic and vascular, compared to 17% in other districts.
Conclusion: PMJAY mirrors the broader inequities in Indian healthcare and society. Its role in financing surgical care is significant, yet uneven. To ensure equity and progress toward universal health coverage, proactive steps such as better monitoring and evaluation of disaggregated data, targeted enrollment of individuals in the bottom quintiles of the “bottom 40%,” and increased allocation to surgical services are needed. PMJAY must evolve not just as a financial safety net but as a systemic driver of equitable surgical care.